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Birkemeier K, Wills HE, Issa T, Farris A, Stacey J, Greene P, Dawood W, Desai K, Laborde C, Trotter B. Pseudoclitoromegaly from acute T-cell lymphoblastic leukemia. Proc AMIA Symp 2023; 36:237-239. [PMID: 36876249 PMCID: PMC9980556 DOI: 10.1080/08998280.2022.2139508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 7-year-old girl presented with painful genital enlargement, which was first believed to be clitoromegaly of hormonal origin. However, on the physical exam the clitoris was not visible and the prepuce and labia minora were enlarged and tender. Magnetic resonance imaging demonstrated an infiltrative abnormal signal with restricted diffusion involving the enlarged clitoris and adjacent soft tissues of the prepuce and labia minora, confirming a nonhormonal infiltrative malignancy. The same abnormal signal was present in enlarged inguinal lymph nodes, the kidneys, and an anterior mediastinal mass. The pathologic diagnosis was T-cell acute lymphoblastic leukemia.
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Affiliation(s)
- Krista Birkemeier
- Texas A&M University Health Science Center, Temple, Texas.,Department of Radiology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Hale E Wills
- Texas A&M University Health Science Center, Temple, Texas.,Department of Surgery, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Tesneem Issa
- Texas A&M University Health Science Center, Temple, Texas.,Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Amanda Farris
- Texas A&M University Health Science Center, Temple, Texas.,Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Joanna Stacey
- Texas A&M University Health Science Center, Temple, Texas.,Department of Obstetrics and Gynecology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Pamela Greene
- Texas A&M University Health Science Center, Temple, Texas.,Department of Obstetrics and Gynecology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Wajahat Dawood
- Texas A&M University Health Science Center, Temple, Texas
| | - Kurren Desai
- Texas A&M University Health Science Center, Temple, Texas.,Department of Radiology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Carrie Laborde
- Texas A&M University Health Science Center, Temple, Texas.,Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Bradley Trotter
- Texas A&M University Health Science Center, Temple, Texas.,Department of Radiology, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
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Fux-Otta C, Fuster M, Ramos N, Trezza C, Ñañez M, Fonseca I, Dicuatro N, Di Carlo M, Bongiorni C, Ochoa J, Rosato O, Chedraui P. Clitoromegaly due to an epidermal inclusion cyst: A case report. Case Rep Womens Health 2022; 35:e00432. [PMID: 35898429 PMCID: PMC9309671 DOI: 10.1016/j.crwh.2022.e00432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Clitoromegaly is often a sign of androgen excess; however, non-hormonal causes must be ruled out. We report the case of an adolescent with isolated clitoromegaly without clinical or biochemical evidence of hyperandrogenism. Case A 16-year-old female was referred due to a clitoromegaly of 12 months of evolution. Examination of the pubic region revealed normal female genitalia with an enlarged clitoris, 4 cm long and 2.5 cm wide. The clitoris was painless, soft on palpation, and mobile over deeper layers. There were no signs of virilization, and the patient did not report dysuria or difficulties with sexual intercourse. Her medical record was also unremarkable, with no female circumcision, family history of birth defects, or genital abnormalities. Hormone profile blood tests were normal. Pelvic ultrasound examination was normal, but a high-resolution scan with a linear transducer confirmed the presence of a cyst, lying anterior to the clitoral body and glans. The cyst was surgically removed with special care to preserve the clitoral neurovasculature. The pathological report disclosed an epidermoid clitoral cyst. The patient described emotional well-being, satisfactory sexual function, and no discomfort after a year of follow-up. Conclusion Epidermal clitoral cysts represent an unusual cause of clitoromegaly. These cysts should be ruled out as a differential diagnosis after an exhaustive semiological and endocrinological examination. An epidermal cyst should be considered after hormonal causes have been excluded for patients with isolated clitoromegaly. Epidermal cysts should be considered in the differential diagnosis of a vulvar mass. Epidermoid cysts require early diagnosis and treatment as they can cause cosmetic and functional impairment.
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Affiliation(s)
- Carolina Fux-Otta
- Departamento de Endocrinología y Diabetes, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
- Unidad de Conocimiento Traslacional Hospitalaria, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
- Corresponding author at: Hospital Universitario de Maternidad y Neonatología de Córdoba, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Rodríguez Peña 285, X5000 Córdoba Capital, Argentina.
| | - Margarita Fuster
- II Cátedra de Clínica Ginecológica, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Noelia Ramos
- Departamento de Endocrinología y Diabetes, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
- Unidad de Conocimiento Traslacional Hospitalaria, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Cristina Trezza
- Cátedra de Anatomía Patológica, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Mónica Ñañez
- Unidad de Conocimiento Traslacional Hospitalaria, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
- II Cátedra de Clínica Ginecológica, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Ismael Fonseca
- Cátedra de Anatomía Patológica, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Néstor Dicuatro
- I Cátedra de Clínica Obstétrica y Perinatología, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Mariana Di Carlo
- Departamento de Endocrinología y Diabetes, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
- Unidad de Conocimiento Traslacional Hospitalaria, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Carla Bongiorni
- Cátedra de Anatomía Patológica, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - José Ochoa
- Diagnóstico por Imágenes, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Otilio Rosato
- Unidad de Conocimiento Traslacional Hospitalaria, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
- II Cátedra de Clínica Ginecológica, Hospital Universitario de Maternidad y Neonatología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba Capital, Argentina
| | - Peter Chedraui
- Facultad de Ciencias de la Salud, Universidad Católica “Nuestra Señora de la Asunción”, Asunción, Paraguay
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The association of Neurofibromatosis Type 1 and lower urinary tract dysfunction in the paediatric population - A critical review of literature. J Pediatr Urol 2020; 16:357-365. [PMID: 32467024 DOI: 10.1016/j.jpurol.2020.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/07/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Neurofibromatosis Type 1 (NF1) is an autosomal dominant, multisystem, neurocutaneous disorder. This condition has been associated with lower urinary tract dysfunction due to either direct genitourinary organ involvement or spinal cord compression. Based on current literature, there are no reviews examining the relationship between NF1 and lower urinary tract dysfunction (LUTD) in the paediatric population. METHODS A critical review of the literature was conducted using a systematic search of MEDLINE, PubMed and Embase yielding a total of 1285 manuscripts published up to 2019. Two independent reviewers selected studies for screening, eligibility and inclusion into the review. Following title, abstract and full-text review, 46 articles were analyzed. RESULTS Within these 46 articles, 79 cases were presented. The mean patient age at the time of presentation was 6.97 ± 9.19 years. The most common urologic presentations were irritative lower urinary tract symptoms (30%) and a newly discovered abdominopelvic mass (21%). Diagnostic investigations commonly demonstrated a retrovesical mass with direct invasion of the bladder in 58 cases (73%) and other genitourinary organ involvement in 39 cases (39%). Throughout the total case volume, LUTD was present in 49%. Pathology of malignancy was most commonly malignant peripheral nerve sheath tumour and rhabdomyosarcoma (20% and 14%, respectively). When indicated, surgical management of the lower urinary tract included both radical and partial cystectomy. Conservative management of urinary retention included clean intermittent catheterization (56%), suprapubic catheterization (22%), vesicostomy creation (11%) and mitrofanoff creation (11%). CONCLUSION A complete urologic evaluation including clinical, radiologic, and possibly pathologic investigation is warranted and should be performed for both diagnosis and appropriate management of LUTD in patients with NF1.
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